The Republican Party’s landmark bill to repeal and replace Obamacare hangs on the balance, threatening to tarnish the legacy of President Donald Trump’s nascent administration and testing House Speaker Paul Ryan’s control of his own conference.
After a dramatic 24 hours of tense negotiations and hushed meetings with the conservative House Freedom Caucus and others that failed to produce a closing deal, GOP leadership and the White House finally acknowledged mid-afternoon that the House would no longer vote Thursday on the GOP health care bill.
They simply didn’t have the votes.
And while White House sources were predicting a Friday vote, GOP aides on Capitol Hill were less optimistic. The suggestion of a Friday vote would be going “too far out,” one senior aide said, while another Republican source said the White House appeared to be pushing a Friday vote to force everyone’s hand.
Republicans can’t lose more than 21 of their caucus and still pass the bill, since no Democrats are expected to support it. According to CNN’s ongoing whip count, 26 House Republicans have said they will vote against the bill, and four more have indicated they are likely to oppose it.
Meanwhile, the Congressional Budget Office came out with more bad news. Changes Republicans made earlier this week to the bill will actually only decrease federal deficits by $150 billion over 10 years, while the original measure would have lowered deficits by $337 billion.
The measure still would leave 24 million fewer people uninsured by 2026 than under Obamacare, CBO said.
The dramatic postponement of the House vote caps a tumultuous few days that have highlighted both Trump’s and Ryan’s struggles to reconcile his own party’s deep and glaring internal divisions.
Both men have been furiously lobbying lawmakers to get behind the legislation. The White House has turned its attention to the Freedom Caucus in its attempt to reach the 216 votes needed pass the bill.
Thursday afternoon, Freedom Caucus members — along with Trump’s senior adviser Steve Bannon, who has been described as being sympathetic to the group’s requests — were seen walking into Ryan’s suite.
But after meeting directly with Trump at the White House Thursday, the Freedom Caucus would not budge.
Freedom Caucus Chairman Mark Meadows said there were “30 to 40” votes against the bill.
“We have not gotten enough of our members to get to yes at this point,” Meadows said. “We are certainly trying to get to yes.”
Meadows also called the long-standing plan to vote on Thursday — the seven-year anniversary of President Barack Obama signing the Affordable Care Act — an “artificial deadline.”
Republican leadership aides threw up their hands, saying it was now up to the Freedom Caucus take it or leave it.
“This is the final offer,” chief deputy whip Patrick McHenry said. “We have a package, they have an offer, and they can accept or reject it.”
A senior administration official described the meeting with one word: “Intense.”
After the vote’s postponement was announced, one senior GOP leadership aide said: “Nothing has changed substantively with the bill since this morning. It’s just a matter of the Freedom Caucus committing to the White House that they are a yes and not moving the goal posts again.”
Moderates are unhappy
While drama has surrounded the Freedom Caucus’ deliberations over the health care bill, the proposal is also in trouble with other factions of the conference.
On Wednesday and Thursday, non-Freedom Caucus Republicans began to turn their backs on the bill, saying it was not a plan they could back on behalf of their constituents.
The moderate Tuesday Group trekked to the White House Thursday afternoon after intense deliberations of their own and a meeting with Ryan. The group had seven boxes of pizza, as well as Doritos and Baked Lays, delivered to a room in the Capitol earlier in the day. Meanwhile, dozens of Republicans have bee circulating from meeting to meeting, including one-on-one sessions with Ryan throughout the day.
Prior to the vote being delayed, press secretary Sean Spicer aired a tone of confidence.
“Through an open and deliberative process, the President and his team have helped to negotiate a very, very strong bill,” Spicer told reporters. “He was on the phone last night well into the 11 p.m. hour with members on an individual basis discussing their support for the bill.”
The challenge for leaders as they count their votes is daunting: Give conservatives too much of what they want and risk losing the moderates, but keep the moderates on board and conservatives could walk.
“This bill is collapsing,” one House Republican, who declined to speak on the record, told CNN Thursday morning.
Frustration with Freedom Caucus
And Trump is now experiencing firsthand what it is like to work with the Freedom Caucus, a top GOP source said — that they can be deeply frustrating because they don’t really want to get to yes and keep changing their demands.
Alabama GOP Rep. Bradley Byrne, emerging from a meeting with top House leaders, blasted the House GOP leadership’s move to continue talks with the hard right in the Freedom Caucus while leaving the bulk of other members in the dark.
“I think the window for making decisions is rapidly closing. We need a vote or go home,” said Byrne, a member of a large group of fiscal conservatives, the Republican Study Committee.
A senior GOP aide said the Freedom Caucus simply won’t close the deal.
“They don’t know how to get to yes. They just don’t. And it’s putting the whole process at risk right now,” the aide said.
A key element of the negotiations between the Freedom Caucus and the White House revolves around the so-called “essential health benefits.” The White House is working to possibly include the repeal of Obamacare requirements that certain benefits — like mental health coverage, drug addiction coverage and maternity care — be required in insurance plans.
But those changes have moderates saying they can’t back the bill.
“It has always been the case — pull the bill one way, risk losing members on the other end,” a lawmaker involved told CNN.
Ryan huddled Wednesday night in his office with his top deputies and GOP moderates. But after several hours, no members came to talk to the reporters waiting outside the meetings. Most members used back exits to leave and the big sticking points remained unresolved.
A member who was in the late-night Ryan meeting said tensions were running high.
“A lot of people don’t realize what the implications of that are,” the member said of stripping out Essential Health Benefits. “So we’re gonna railroad this thing through and there’s going to be even more people pissed off — our constituents, stakeholders.”
Many GOP members are frustrated with how leadership has handled the negotiations in the past 24 hours.
“I think the chances for getting a bill done this week gets smaller — doesn’t go to zero, no such thing as never or impossible — but I think the chances of passing this bill get a … lot lower if we don’t do it this week,” one member said.
“The vast majority of us in the Republican conference have been left out of these discussions and we have no idea what’s going on, and I think that is a problem for our leadership and I think it’s a growing problem for the chances of this bill,” said Byrne, who is a supporter of the health care bill and part of the whip operation to help pass it.
What’s in the bill
The GOP health care bill, introduced earlier this month, would roll back many of the Obamacare taxes and eradicate the individual mandate. Instead of the subsidies available under Obamacare, officially known as the Affordable Care Act, the GOP plan provides Americans with refundable tax credits to purchase health insurance.
The bill also significantly restructures Medicaid and allows states to require able-bodied adults to work if they want to be eligible for the program. After 2020, states will no longer be able to expand Medicaid like they could under Obamacare and states that haven’t expanded the program at all are barred from doing so.
However, the GOP bill still includes some of the most popular pieces of Obamacare, including letting children stay on their parents’ insurance plans until the age of 26 and including protections for people with pre-existing conditions, though insurers would be allowed to charge higher premiums to individuals whose coverage has lapsed.
The non-partisan CBO estimated that 24 million fewer Americans would be covered under this bill than under Obamacare by 2026 if the bill is becomes law in its current form.